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Carcinogen Biomarkers in the Urine of Electronic Cigarette Users and Implications for the Development of Bladder Cancer: A Systematic Review - Beyond the Abstract

Electronic cigarette (e-cigarette) use, colloquially known as “vaping,” is a public health crisis in the United States with an exponential rise in use over the last several years. E-cigarettes have been marketed as a safer alternative to smoking and studied as a tobacco smoking cessation aid.1-3 The Food and Drug Administration affirms that there are health risks associated with using e-cigarettes citing the harmful aerosolized and inhaled contents during the vaping process. Yet, the safety profile of e-cigarettes, especially as it pertains to bladder cancer risk has not been definitively characterized. Given the large and increasing use of e-cigarettes, especially among the youth, there is a pressing need to understand the health implications of vaping.4

In our article “Carcinogen Biomarkers in the Urine of Electronic Cigarette Users and Implications for the Development of Bladder Cancer: A Systematic Review” we found that similar to combustible tobacco smokers, e-cigarette users are exposed to a variety of toxic and carcinogenic compounds during the vaping process. Specifically, toxic and carcinogenic metabolized byproducts were found in the urine of e-cigarette users. These urinary carcinogens, such as polycyclic aromatic hydrocarbons and volatile organic compounds, have a direct causative relationship to the development of bladder cancer.

Our study was limited by the heterogeneous study population. Several studies included dual users; those who used e-cigarettes and combustible cigarettes, which made it difficult to assess whether the carcinogen found in the urine was specifically from the e-cigarette use or from the combustible cigarette use. In order to address these limitations and further examine the potential impact of vaping on bladder cancer, we have now initiated several additional avenues of investigation. First, we are conducting a multi-institutional collaboration assessing several different bladder cancer-related carcinogens in the urine of e-cigarette only users, never users, and combustible tobacco users to quantify and compare the presence of these toxicants using liquid chromatography-mass spectrometry. Second, in order to identify early genetic alterations linked to the bladder that may be occurring in e-cigarette users, we are assessing DNA methylation changes in bladder cancer-related genes along with the prevalence of telomerase reverse transcriptase (TERT) promoter mutations. Lastly, to control for the heterogeneity of human studies, we are investigating the direct impact of vaping on the urothelium of mice models at the genomic and epigenetic levels. These studies, taken together, will help to better elucidate the health and bladder cancer-related consequences of e-cigarettes use.

Written by: Ibardo A. Zambrano MD, William Y. Kim, MD, Marc A. Bjurlin DO, MSc, FACOS, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, Twitters: @ibardo_zambrano, @WilliamKimMD, @MABjurlin; Richard Matulewicz, MD, MS, NYU Langone Medicine, Depts. of Urology and Population Health, New York City, New York, Twitter: @RichMatulewicz

References: 

  1. Yeh, James S., Christopher Bullen, and Stanton A. Glantz. "E-cigarettes and smoking cessation." New England Journal of Medicine 374, no. 22 (2016): 2172-2174.
  2. Bullen, Christopher, Colin Howe, Murray Laugesen, Hayden McRobbie, Varsha Parag, Jonathan Williman, and Natalie Walker. "Electronic cigarettes for smoking cessation: a randomised controlled trial." The Lancet 382, no. 9905 (2013): 1629-1637.
  3. Caponnetto, Pasquale, Davide Campagna, Fabio Cibella, Jaymin B. Morjaria, Massimo Caruso, Cristina Russo, and Riccardo Polosa. "EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as tobacco cigarettes substitute: a prospective 12-month randomized control design study." PloS one 8, no. 6 (2013).
  4. Cullen, Karen A., Andrea S. Gentzke, Michael D. Sawdey, Joanne T. Chang, Gabriella M. Anic, Teresa W. Wang, MeLisa R. Creamer, Ahmed Jamal, Bridget K. Ambrose, and Brian A. King. "E-Cigarette use among youth in the United States, 2019." Jama 322, no. 21 (2019): 2095-2103.
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